Major laparoscopic hepatectomy along the major hepatic veins requires accurate orientation to the transection plane and safe management of the hepatic venous branches. We developed an extracorporeal ventral traction (EVT...Major laparoscopic hepatectomy along the major hepatic veins requires accurate orientation to the transection plane and safe management of the hepatic venous branches. We developed an extracorporeal ventral traction (EVT) method combined with a 3-step dorsal approach (3SDA) to standardize laparoscopic hemihepatectomy. In EVT, a traction suture secured on the caudal edge of the transection line is brought out through the epigastrium and pulled extracorporeally, elevating the liver parenchyma ventrally and allowing dorsal access under the caudal laparoscopic view. In 3SDA, the transection plane containing the major hepatic vein is divided into three areas: Area A, caudal to the hilum; Area B, dorsal to the hepatic vein; and Area C, ventral to the hepatic vein. These areas are approached sequentially to open the caudal view, maintain anatomical landmarks, and reduce venous injury. EVT and 3SDA provide a reproducible framework for laparoscopic hemihepatectomy.
PURPOSE: This study aimed to clarify the timing and motivations behind decisions to pursue a surgical career and identify optimal recruitment strategies. METHODS: A nationwide questionnaire was administered to newly cert...PURPOSE: This study aimed to clarify the timing and motivations behind decisions to pursue a surgical career and identify optimal recruitment strategies. METHODS: A nationwide questionnaire was administered to newly certified surgical trainees. Respondents were classified into two groups based on when they decided to pursue surgery: before junior residency (BJR) or during/after junior residency (DJR). The backgrounds and motivations were compared. RESULTS: Among the 758 respondents (53.8%), 25.6% were female. Male trainees were more likely to decide to pursue surgery before medical school (18.7% vs. 9.4%, p = 0.003), whereas female trainees more often decided during their PGY-2 (35.4% vs. 24.1%, p = 0.002). The DJR group included more women (30.3% vs. 21.7%, p = 0.014) and residents from urban areas (46.6% vs. 36.7%, p = 0.008). The BJR group was more influenced by the images of surgeons and family. Among female residents, those in the DJR group were more influenced by recruitment from the surgeons. CONCLUSIONS: This study demonstrated sex differences in the timing and motivation for pursuing a surgical career. Understanding the optimal timing and appealing factors for recruiting surgeons, particularly women, could inform more effective recruitment strategies.
Omiya S, Urade T, Komatsu S
… +12 more, Fukushima K, So S, Yoshida T, Arai K, Akita M, Mizumoto T, Ishida J, Nanno Y, Asari S, Yanagimoto H, Kido M, Fukumoto T
PURPOSE: This study aimed to evaluate preoperative malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine whether its prognostic impact after initial liver resection (LR) differ...PURPOSE: This study aimed to evaluate preoperative malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine whether its prognostic impact after initial liver resection (LR) differs between older (≥70 years) and younger (<70 years) patients with hepatocellular carcinoma (HCC). METHODS: This retrospective analysis included 330 patients with HCC who underwent LR between January 2011 and December 2019 at our institution. Overall survival (OS), recurrence-free survival (RFS), postoperative recurrence patterns, and treatment strategies for recurrence were compared between the two groups. RESULTS: Among the 330 patients with HCC, 150 and 180 were classified into younger and older groups, respectively. Preoperative severe malnutrition was independently associated with OS (p=0.001) and RFS (p=0.044) in older patients and with RFS (p=0.039), but not OS, in younger patients. Moreover, in older patients, preoperative malnutrition was associated with a lower rate of aggressive treatments for intrahepatic recurrence (p=0.018) and a higher rate of extrahepatic recurrence (p=0.023) after LR, which was not observed in younger patients. CONCLUSIONS: Severe malnutrition, as per the GLIM criteria, is a significant independent predictor of OS and RFS in older patients with HCC who underwent LR. Preoperative malnutrition was associated with the treatment strategies for intrahepatic recurrence and the rate of extrahepatic recurrence in this population.
Temporary epicardial pacing wires (TEPWs) are used widely for rhythm management in cardiac surgery. However, their routine placement is being debated increasingly because of low utilization and potential procedural risks...Temporary epicardial pacing wires (TEPWs) are used widely for rhythm management in cardiac surgery. However, their routine placement is being debated increasingly because of low utilization and potential procedural risks. We compared routine versus selective TEPW placement practices and assessed the utilization, complications, and predictors of pacing need. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Cochrane Library until June 2025. Studies were included if they examined TEPW strategies in adult or pediatric cardiac surgery and reported outcomes related to wire use, complications, or predictors of pacing need. Eleven studies involving 16,874 patients (14,957 adults, 1,917 children) were included. Routine placement rates ranged from 73.5% to 89.9%, but utilization was low at 2.9%-29.6%. Selective strategies showed higher utilization of 30%-100% with fewer unused wires. Predictors of the need for TEPW included intraoperative arrhythmias, prolonged CPB, and complex procedures. Complications were rare. Thus, routine TEPW placement often leads to unnecessary wire use. Selective strategies based on intraoperative and clinical predictors may optimize patient care. Developing a risk-based tool could enhance decision-making and reduce procedural burden.
PURPOSES: Robotic transabdominal preperitoneal repair (R-TAPP) is being adopted increasingly for inguinal hernia. However, there is limited evidence about how its short-term outcomes compare with those of laparoscopic TA...PURPOSES: Robotic transabdominal preperitoneal repair (R-TAPP) is being adopted increasingly for inguinal hernia. However, there is limited evidence about how its short-term outcomes compare with those of laparoscopic TAPP (L-TAPP). We evaluated the safety and efficacy of R-TAPP at a single institution. METHODS: We reviewed 980 inguinal hernia repairs (R-TAPP 82, L-TAPP 898) performed between January 2021 and July 2025 at our institution. The primary outcome was operative time and the secondary outcomes were intraoperative blood loss, postoperative hospital stay, complications, and chronic pain. This study was restricted to procedures performed by Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons, using propensity score matching (PSM) and inverse-probability of treatment weighting (IPTW) analysis. RESULTS: The operative times for both unilateral and bilateral repairs were significantly shorter in the R-TAPP group than in the L-TAPP group (69.5 min vs. 96.0 min and 114.0 min vs. 150.0 min, respectively; both p < 0.001), even after PSM (69.0 min vs. 84.0 min, p < 0.001). Using IPTW, R-TAPP was associated with a 16.7 min reduction in operative time compared with L-TAPP (p < 0.001). Intraoperative blood loss was significantly lower with R-TAPP, but there were no significant differences in the other secondary outcomes. CONCLUSIONS: R-TAPP reduces the operative time required without compromising perioperative safety, supporting its use as a safe and efficient option for inguinal hernia repair.
PURPOSE: Intrahepatic cholangiocarcinoma (ICC) with pathological lymph node metastasis (LNM) is associated with a poor prognosis. The standard treatment for ICC is surgical resection; however, the importance of prophylac...PURPOSE: Intrahepatic cholangiocarcinoma (ICC) with pathological lymph node metastasis (LNM) is associated with a poor prognosis. The standard treatment for ICC is surgical resection; however, the importance of prophylactic lymph node dissection (LND) is unclear. This study examined the predictive value of preoperative imaging for LNM from ICC. METHODS: Forty patients with ICC underwent preoperative diagnostic imaging using contrast-enhanced computed tomography (CT), gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI), and positron emission tomography (PET)-CT, followed by liver resection with LND. Lymph node (LN) size (≥ 10 mm) and the presence of poor-contrast areas in LNs were evaluated using CT and EOB-MRI. Visually assessed positive LNs were evaluated by PET-CT. RESULTS: LN size measured on CT and EOB-MRI could not predict pathological LNM. However, poor-contrast areas in LNs measured on CT (sensitivity, 55.0%; specificity, 95.0%) and EOB-MRI (sensitivity, 75.0%; specificity, 95.0%) could predict pathological LNM (pLNM), as could visually assessed positive LNs measured on PET-CT (sensitivity, 50.0%; specificity, 100.0%). LNs with poor-contrast areas measured on CT or MRI were an independent predictor of pLNM. CONCLUSION: LNM was predicted by evaluating LNs with poor-contrast areas using contrast-enhanced CT or EOB-MRI. Thus, LNM risk should be assessed using EOB-MRI or/and contrast-enhanced CT scans before surgery.
PURPOSE: Minimally invasive surgery (MIS) has improved the management of colorectal cancer (CRC), offering reduced morbidity without compromising the oncological outcomes. However, its role in locally advanced colon canc...PURPOSE: Minimally invasive surgery (MIS) has improved the management of colorectal cancer (CRC), offering reduced morbidity without compromising the oncological outcomes. However, its role in locally advanced colon cancer and its impact on the Textbook Outcome (TO)-a metric integrating key surgical success parameters- remain unclear. METHODS: This retrospective study analyzed the data of 459 patients with T3/T4 colon cancer who underwent elective resection at Keio University Hospital between 2012 and 2020. TO was defined as R0 resection, ≥ 12 lymph nodes harvested, no severe complications, no unplanned stoma, and timely surgery. Multivariate regression was used to identify the factors influencing TO and overall survival (OS). RESULTS: TO was achieved in 59.0% of patients, with higher rates in MIS than in open surgery (64.3% vs. 28.4%, p < 0.001), particularly for right-sided tumors. The predictors of TO non-achievement included a high Controlling Nutritional Status (CONUT) score, advanced stage, and left-sided tumors. Patients achieving TO had a significantly improved 5-year OS (p < 0.001) after a median follow-up of 49.3 months. CONCLUSION: MIS reliably achieves TO, especially in right-sided colon cancer, emphasizing the importance of multidisciplinary preoperative planning. TO is a valuable metric for assessing surgical quality while also correlating with an improved long-term survival in locally advanced CRC.
PURPOSE: Surgeons frequently encounter early postoperative intermediate transvalvular gradients (20-40 mmHg, "grey zone") after aortic valve replacement (AVR). We investigated whether these gradients compromise short-ter...PURPOSE: Surgeons frequently encounter early postoperative intermediate transvalvular gradients (20-40 mmHg, "grey zone") after aortic valve replacement (AVR). We investigated whether these gradients compromise short-term clinical stability or represent a transient, clinically compensated phase, marked by systemic mechanical stress. METHODS: We retrospectively evaluated 141 consecutive isolated AVR patients, stratified by pre-discharge mean gradients: Group 1 (> 20 mmHg, n = 66) and Group 2 (≤ 20 mmHg, n = 75). We analyzed short-term clinical outcomes and systemic mechanical stress markers (neutrophil-to-lymphocyte ratio [NLR] and lactate dehydrogenase [LDH] levels). RESULTS: The operative characteristics were similar between the groups. Group 1 exhibited elevated median NLR (3.8 vs. 2.1, p < 0.001) and LDH (304.0 vs. 115.5 U/L, p < 0.001) levels. Despite this biochemical activation, the short-term mortality and reoperation rates were comparable between the two groups. Although Group 1 experienced more frequent non-valvular readmissions (13.6% vs. 2.6%, p = 0.024), their mean gradients demonstrated significant spontaneous regression by 6 months (23.5 to 19.8 mmHg, p < 0.01). CONCLUSION: Early "grey zone" gradients are associated with a distinct mechanical stress profile characterized by elevated NLR and LDH levels but do not appear to compromise short-term valvular stability. The spontaneous gradient regression and absence of excess mortality support a safe "watchful waiting" approach, thus avoiding premature reinterventions while maintaining close clinical surveillance. CLINICAL TRIAL REGISTRATION: This study was not registered as a clinical trial because it was a retrospective observational study.
PURPOSE: Hepatic venous outflow block (HVOB) is a potentially serious complication after hepatectomy. Although routine anatomical fixation of the remnant liver is often advocated to prevent HVOB, its universal necessity...PURPOSE: Hepatic venous outflow block (HVOB) is a potentially serious complication after hepatectomy. Although routine anatomical fixation of the remnant liver is often advocated to prevent HVOB, its universal necessity remains controversial. We conducted this study to evaluate the utility of intraoperative Doppler ultrasonography for guiding selective remnant liver fixation. METHODS: A total of 26 patients who underwent right-sided or central hepatectomy with transection of the falciform ligament between April 2016 and January 2025 were enrolled prospectively in this study. Intraoperative Doppler ultrasonography was used to assess venous flow in spontaneous and anatomical liver positions. Fixation using the round ligament, with or without the falciform ligament, was performed selectively when venous outflow impairment was observed. RESULTS: Eight patients (31%) required fixation. Portal vein thrombosis occurred in five patients, including one with concurrent hepatic vein thrombosis caused by incorrect positioning. Apart from the illustrative case, all thrombotic events were asymptomatic and resolved with anticoagulation. Postoperative complications and liver regeneration were comparable between the groups. Postoperative abdominal discomfort was more frequent in the anatomical group, but the difference was not significant. CONCLUSION: Intraoperative Doppler ultrasonography may facilitate on-demand remnant liver fixation by allowing real-time assessment of venous outflow impairment. This approach may help prevent complications and avoid unnecessary fixation.
PURPOSE: Long-term renal outcomes after ileostomy closure in patients undergoing curative colorectal tumor resection and diverting ileostomy remain unclear. We investigated renal outcomes and risk factors for chronic kid...PURPOSE: Long-term renal outcomes after ileostomy closure in patients undergoing curative colorectal tumor resection and diverting ileostomy remain unclear. We investigated renal outcomes and risk factors for chronic kidney disease (CKD) in this population. METHODS: Patients who underwent colorectal tumor surgery after diverting ileostomy between January 2013 and December 2020 were analyzed. The serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR) were monitored for up to three years after stoma closure. CKD progression was defined as an eGFR < 60 mL/min/1.73 m. A multivariate analysis was used to identify independent risk factors for CKD. RESULTS: In total, 533 patients were included: 112 with preoperative CKD and 421 without CKD. Among patients without preoperative CKD, 322 were followed up for 3 years after stoma closure. sCr levels and the eGFR showed persistent worsening even after stoma closure. Based on the eGFR at three years, patients were grouped into CKD and non-CKD groups. A multivariate analysis revealed that age ≥ 70 years old, a preoperative eGFR < 90 mL/min/1.73 m, and ileostomy-associated kidney injury were independent risk factors for CKD after stoma closure. The sCr levels and eGFR worsened up to three years after stoma closure, even without these risk factors. CONCLUSIONS: Diverting ileostomy poses a risk of a renal function decline even after stoma closure.
PURPOSE: This study aimed to assess the textbook outcomes (TO) after minimally invasive lung cancer surgery and identify factors associated with TO failure. METHODS: This retrospective study included 853 patients with cl...PURPOSE: This study aimed to assess the textbook outcomes (TO) after minimally invasive lung cancer surgery and identify factors associated with TO failure. METHODS: This retrospective study included 853 patients with clinical stage I lung cancer who underwent minimally invasive resection between 2015 and 2025 at our institution. TO was defined using predefined perioperative events. A logistic regression analysis was performed to identify the factors associated with TO failure. Cause-specific mortality was evaluated using a competing risk analysis. RESULTS: Of the 853 patients, 647 (75.8%) achieved TO. Prolonged air leaks, reintervention, arrhythmia, prolonged hospital stay, and pneumonia were the main factors associated with TO failure. Smoking history and respiratory comorbidities were independent risk factors for TO failure. Segmentectomy was associated with a higher likelihood of achieving TO in the present study. At 5 years, no significant difference in the incidence of cancer-related death was observed between the TO and non-TO groups (5.4% vs. 4.2%, P = 0.841). However, the incidence of noncancer-related death was significantly higher in the non-TO group (13.5% vs. 10.5%, P = 0.004). CONCLUSION: TO was achieved in most patients who underwent minimally invasive surgery. TO failure was significantly associated with a smoking history, respiratory comorbidities, surgical procedures, and an increased incidence of noncancer-related death after minimally invasive surgery.
The effectiveness of gastrointestinal bypass surgery for treating non-strangulated adhesive small bowel obstruction (ASBO) remains unclear. We aimed to compare the outcomes of gastrointestinal bypass and conventional sur...The effectiveness of gastrointestinal bypass surgery for treating non-strangulated adhesive small bowel obstruction (ASBO) remains unclear. We aimed to compare the outcomes of gastrointestinal bypass and conventional surgery in patients with non-strangulated ASBO who were unresponsive to conservative treatment. The patients (n = 55) were divided into a bypass group (n = 15) undergoing bypass surgery and a non-bypass group (n = 40) undergoing conventional surgery, including adhesiolysis or small bowel resection. The serum albumin levels and prognostic nutritional index were comparable between the two groups at 12 months postoperatively. No patients (0%) in the bypass group and 13 (32.5%) in the non-bypass group experienced recurrent ASBO after surgery (p = 0.008). The recurrence-free survival was significantly longer in the bypass group than in the non-bypass group (p = 0.030). Gastrointestinal bypass surgery may reduce long-term recurrence and thus represents a promising alternative surgical strategy for non-strangulated ASBO.
PURPOSE: Neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is commonly used for esophageal squamous cell carcinoma in Japan, but it often causes chemotherapy-induced diarrhea (CID), thus impairing the qu...PURPOSE: Neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy is commonly used for esophageal squamous cell carcinoma in Japan, but it often causes chemotherapy-induced diarrhea (CID), thus impairing the quality of life. We investigated the association between a trace element-enriched collagen peptide beverage (CP10) and CID during DCF therapy. METHODS: This retrospective study included 94 patients who underwent radical esophagectomy following DCF therapy (January 2023-December 2025). During the first DCF cycle, 26 patients consumed CP10 daily (CP+ group), whereas 68 did not (CP- group). The primary endpoint was CID incidence during the first DCF cycle, assessed using the Common Terminology Criteria for Adverse Events. A multivariable logistic regression analysis was performed to adjust for any potential confounders. RESULTS: Grade ≥ 1, ≥2, and ≥ 3 CID occurred in 15%, 15%, and 12% of the CP+ group versus 46%, 38%, and 32% of the CP- group, respectively. CP10 use was associated with a lower incidence of CID across all severity grades. In the multivariable analysis, this association remained statistically significant for grade ≥ 1 CID (adjusted OR 0.22, 95% CI 0.05-0.74; P = 0.013). Sensitivity analyses yielded consistent estimates (adjusted OR 0.15-0.28). CONCLUSION: CP10 use was associated with a lower incidence of CID during DCF therapy.
It is important that axillary surgery is optimized for de-escalation in the era of sentinel lymph node biopsy for early breast cancer. Several randomized trials of clinically node-negative breast cancer have demonstrated...It is important that axillary surgery is optimized for de-escalation in the era of sentinel lymph node biopsy for early breast cancer. Several randomized trials of clinically node-negative breast cancer have demonstrated the non-inferiority of regional lymph node recurrence and distant metastasis in women aged ≥ 50 years with small tumors of the luminal subtype who did not undergo axillary surgery compared with those who underwent sentinel lymph node biopsy. Tailored axillary surgery has been attempted to personalize axillary management in patients with clinically node-positive breast cancer treated with neoadjuvant chemotherapy. Image-guided localization, such as clipping, has been shown to accurately diagnose lymph node involvement and reduce the rate of false negatives for sentinel lymph node biopsy. This technique also reduces regional lymph node recurrence, although regional nodal irradiation and adjuvant therapy are usually required for this purpose. In this review, we aimed to facilitate the optimization of axillary surgery for patients with clinically node-negative and node-positive breast cancer by discussing the findings of randomized trials and our own experiences at the Japanese Society for Sentinel Node Navigation Surgery.
Harada T, Numata M, Atsumi Y
… +17 more, Fukuda T, Izukawa S, Nukada S, Kazama K, Numata K, Godai T, Sugano N, Mushiake H, Higuchi A, Katayama Y, Mikayama Y, Suwa Y, Ozawa M, Sato T, Yukawa N, Saito A, Yoshikawa T
PURPOSE: To clarify sex-specific differences in the risk profiles of anastomotic leakage (AL) after rectal cancer surgery, for which sex is widely recognized as an important risk factor. METHODS: This retrospective multi...PURPOSE: To clarify sex-specific differences in the risk profiles of anastomotic leakage (AL) after rectal cancer surgery, for which sex is widely recognized as an important risk factor. METHODS: This retrospective multicenter study included 1,854 patients (1,196 men and 658 women) who underwent rectal cancer surgery with anastomosis between 2015 and 2025 at our institution. Patients were stratified by sex, and risk factors for AL (grade ≥ B) were analyzed separately using logistic regression. Interaction analyses between sex and perioperative factors were also conducted. RESULTS: AL occurred more frequently in men than in women (9.9% vs. 4.1%, respectively). In sex-stratified multivariate analyses, an anastomotic site ≤ 5 cm from the anal verge and transanal tube placement were identified as independent risk factors for AL in men, whereas minimally invasive surgery and the use of indocyanine green fluorescence imaging were associated with a reduced risk of AL. In women, a preoperative C-reactive protein-to-albumin ratio ≥ 0.07 and operative period were independent risk factors for AL. A significant interaction was observed between sex and low anastomosis rates. CONCLUSION: Sex-specific differences in AL risk profiles have been suggested. Sex-specific risk assessment may contribute to more individualized strategies for diverting stoma decision-making.
PURPOSE: Social media has emerged as an important tool for disseminating information to medical students; however, their platform preferences and usage purposes remain unclear. METHODS: We conducted a multicenter web-bas...PURPOSE: Social media has emerged as an important tool for disseminating information to medical students; however, their platform preferences and usage purposes remain unclear. METHODS: We conducted a multicenter web-based survey of medical students from eight Japanese medical schools in 2025, assessing their overall social media use, platform preferences by purpose, daily usage time, and the perceived usefulness of social media for career decision-making. RESULTS: A total of 1,515 students participated in this study. YouTube (71.6%), Instagram (65.1%), and X (43.7%) were frequently used platforms, whereas Facebook (1.9%) was rarely used. Platform use differed by academic year: YouTube use was significantly higher among early-year students, whereas X use was significantly more common among advanced-year students (P = 0.043 and P < 0.001, respectively). Overall, 763 respondents (50.4%) perceived social media as useful for career decision-making, with X being used most frequently for this purpose, followed by YouTube and Instagram; this perception was significantly more common among the early-year students (P = 0.005). CONCLUSIONS: These findings provide valuable insights for educators and professional organizations seeking to engage medical students through social media. Understanding these trends is especially important as Japan faces a shortage of surgeons.
Chewing gum may stimulate gut motility through a "sham feeding" mechanism, but evidence in children is limited. We performed an updated systematic review and meta-analysis of randomized controlled trials comparing chewin...Chewing gum may stimulate gut motility through a "sham feeding" mechanism, but evidence in children is limited. We performed an updated systematic review and meta-analysis of randomized controlled trials comparing chewing gum plus usual care versus usual care alone in patients younger than 18 years undergoing any surgery. We searched five databases through June 2025. Primary outcomes were the time to first flatus, time to first defecation, and postoperative length of stay (LOS). Certainty was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Ten studies (n = 649) were included: abdominal surgery (5), spinal fusion (3), and tonsillectomy (2). Chewing gum may result in little to no difference in the time to first flatus (MD - 3.58 h, 95% CI - 8.08 to 0.91) or first defecation (MD - 3.23 h, 95% CI - 6.63 to 0.18), both with low certainty. LOS evidence was very uncertain (MD - 0.18 days, 95% CI - 0.70 to 0.33). Subgroup analyses suggested shorter LOS after abdominal surgery (MD - 0.60 days, 95% CI - 1.99 to 0.79) but not after spinal fusion (MD 0.10 days, 95% CI - 0.29 to 0.50; p for interaction = 0.0362). The benefits of postoperative chewing gum in children remain uncertain, with potential surgery-specific differences in LOS warranting investigation.
PURPOSE: Current guidelines recommend both anterior and posterior approaches for groin hernia repair; however, open preperitoneal techniques remain underrepresented due to the limited availability of large-scale data. Th...PURPOSE: Current guidelines recommend both anterior and posterior approaches for groin hernia repair; however, open preperitoneal techniques remain underrepresented due to the limited availability of large-scale data. This study evaluated the perioperative and short-term outcomes of a tailored open groin hernia repair strategy in an ambulatory setting. METHODS: This retrospective single-center study included all adult patients who underwent open groin hernia repair between April 2003 and November 2021 at a specialized ambulatory clinic in Japan. Repair techniques were individualized according to hernia morphology and patient characteristics, incorporating anterior and preperitoneal approaches. Perioperative variables, complications, chronic pain, and recurrence were analyzed descriptively using the SPSS software program. RESULTS: A total of 7,424 patients with 7,516 groin hernia lesions were included in the analysis. Indirect hernias accounted for 73.8% of the lesions, and preperitoneal repair was the most frequently performed procedure (60.9%). Most procedures were performed under local anesthesia (70.7%). The mean operative time was 52.7 ± 13.5 min. Postoperative complications occurred in 0.34%, reoperation in 0.07%, and unplanned admission in 0.13%. Chronic pain was observed in three patients in the study. Recurrence occurred in 0.41% of patients at a mean follow-up of 68.1 ± 65.8 months. CONCLUSION: Tailored open groin hernia repair can be safely implemented in a high-volume ambulatory setting, supporting individualized open strategies beyond the conventional Lichtenstein technique.
Long-term non-cancer mortality following lung cancer surgery remains an under-recognized challenge in clinical practice. This review proposes a novel "pulmonary hypertensive phenotype" hypothesis, suggesting that the per...Long-term non-cancer mortality following lung cancer surgery remains an under-recognized challenge in clinical practice. This review proposes a novel "pulmonary hypertensive phenotype" hypothesis, suggesting that the permanent reduction of the pulmonary vascular bed after anatomical resection acts as the primary upstream driver of systemic vulnerability. While the ventilatory capacity may partially recover through enlargement of the airspace and compensatory remodeling, restoration of the pulmonary vascular bed is often incomplete. This deficit leads to a sustained right ventricular afterload and chronic endothelial stress. We integrated clinical and experimental evidence to suggest that this cardiopulmonary strain triggers systemic catabolic signaling, potentially mediated by factors such as GDF-15, which accelerates skeletal muscle proteolysis and attrition. This metabolic "phase-shift" can push patients beyond a critical threshold of vulnerability, increasing the risk of sarcopenia and non-cancer death. This could be particularly evident after extensive resections, such as pneumonectomy and lobectomy, compared with sublobar-sparing approaches. Ultimately, surgical invasiveness should be re-evaluated not only by lung volume loss but also by the preservation of the pulmonary vascular bed necessary to maintain systemic homeostasis. This framework provides a biologically plausible pathway linking the extent of resection to long-term systemic resilience and should be regarded as a conceptual integrative model that requires clinical validation.